Physical fitness in survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort

Abstract

Background There are limited data describing fitness and associated health‐related quality of life (HRQoL) in survivors of childhood Hodgkin lymphoma (HL). Procedure Fitness was evaluated among 336 adult survivors of childhood‐onset HL treated at St. Jude Children's Research Hospital and 327 controls who never had childhood cancer. The controls were frequency matched on age, sex, and race. Associations were examined between chronic disease and fitness and between fitness and HRQoL using a multivariable linear and logistic regression. Results Male survivors had lower endurance (6‐min walk [6MW] distance 604.4 ± 7.9 m vs 637.0 ± 7.5 m, P < 0.01), and worse neuropathy (modified Total Neuropathy Score [mTNS] 2.7 ± 0.2 vs 1.4 ± 0.2, P < 0.01) compared to controls. Female survivors had lower endurance (6MW distance 564.5 ± 6.9 m vs 590.6 ± 7.0 m, P < 0.01), quadriceps strength (145.7 ± 4.0 vs 163.4 ± 4.0 N·m per kilogram, P < 0.01), and worse neuropathy (mTNS 3.2 ± 0.2 vs 1.4 ± 0.3, P < 0.01) compared to controls. Moderate, severe/disabling, or life‐threatening (grades 2‐4) neurological conditions were associated with impaired quadriceps strength (odds ratio [OR] 2.94, 99% confidence interval [CI] 1.24‐6.96) and impaired endurance (OR 2.96, 99% CI 1.28‐6.69). Cardiovascular (OR 2.36, 99% CI 1.00‐5.61) and pulmonary (OR 2.78, 99% CI 1.30‐5.94) conditions were associated with impaired endurance. Quadriceps strength (β –6.44 ± 2.01, P < 0.01), endurance (β –4.63 ± 1.54, P < 0.01), and neuropathy (β –4.98 ± 1.14, P < 0.01) were associated with a lower physical component summary on the HRQoL. Conclusion Survivors of childhood HL, particularly those with neurological, cardiac, and pulmonary chronic conditions, are at risk for impaired fitness and HRQoL.

Enfoques predominantes en los estudios sobre calidad de vida relacionada a la salud de jóvenes sobrevivientes de cáncer en la infancia o adolescencia. Revisión integradora de la literatura científica

“…Fuente: Autores. [15][16][17] , dos de linfoma 18,19 , uno de tumor óseo 20 , uno de rabdomiosarcoma 21 , uno de tumor de Wilms 22 , uno en tumores de cráneo y cuello 23 , uno en tumores de sistema nervioso central 24 , y 27 en poblaciones que tomaban en conjunto sobrevivientes de distintos tipos de cáncer . Entre los 11 trabajos cuyo objetivo fue estudiar aspectos de medición de CVRS, ocho estaban dedicados al desarrollo, validación, comparación o evaluación de distintos instrumentos de medición de la calidad de vida relacionada a la salud [52][53][54][55][56][57][58][59] y solo en tres también se estudiaron cuestiones como significancia clínica, sesgo de respuesta o posibles contenidos perdidos durante el estudio de la CVRS [60][61][62] .…”

“…c) Enfocadas en aspectos psico-sociales, o de comportamiento que influyeran la CVRS: dentro de esta línea de investigación se incluyeron 12 artículos cuyo objetivo fue estudiar algunos factores propuestos por los investigadores como posibles determinantes de la CVRS en sobrevivientes de cáncer en la infancia o adolescencia. Entre estos factores se exploraron: aspectos relacionados con estilos de vida saludable (tres artículos) 19,46,49 ; la pertenencia, o no, a la cultura latina o tener síntomas de depresión (un artículo) 50 o pertenecer a la cultura latina (un artículo) 42 ; disparidades en aspectos neurocognitivos o emocionales según la etnicidad (un artículo) 51 ; aspectos relacionados con el cáncer (un artículo) 45 ; características relacionadas con la autoestima y aspectos psicosociales (cuatro artículos) 43,44,47,48 , y el funcionamiento familiar como mediador de la función neurocognitiva en sobrevivientes de tumores cerebrales (un artículo) 24 . Al igual que lo observado con anterioridad en la mayoría de los trabajos, la metodología fue cuantitativa, a pesar de las limitaciones que implica este tipo de abordaje.…”

Predominant approaches in studies on health-related quality of life of young survivors of childhood or adolescent cancer: an integrative literature review

“…The majority of the articles were published between Cuadro 1 details all of the articles included in this review, according to their classification for analysis, first author and publication year. Among the first group of 37, 10 were carried out in survivors of a specific cancer (three in survivors of leukemia survivors [15][16][17] , two in lymphoma survivors 18,19 , one in bone tumor survivors 20 , one in rhabdomyosarcoma survivors 21 , one in Wilms tumor survivors 22 , one in head and neck tumor survivors 23 , one in survivors of tumors of the central nervous system 24 , and 27 in populations of survivors of different types of cancer . Among the 11 works with the objective of studying specific aspects mediating HRQOL, 8 looked at the development, validation, comparison or evaluation of different instruments to measure health-related quality of life [52][53][54][55][56][57][58][59] and in only three questions of clinical significance, response bias or possible missing content in the study of HRQOL were examined [60][61][62] .…”

Closing the survivorship gap in children and adolescents with Hodgkin lymphoma

“…Myocardial infarction and structural heart defects were prevalent contributors to the excess burden in survivors and were associated with high cardiac radiation dose (≥35 Gy), reflecting the treatment era of extended field approaches. Survivors of childhood HL, particularly those with neurological, cardiac and pulmonary chronic conditions, are at risk for impaired fitness and diminished HRQoL (Wogksch et al , ). Long term survivorship studies to date have been unable to sort out the added burden of salvage therapy, specifically autologous HSCT, underlying late effects and premature mortality.…”